Somatic correlates of comorbid major depression in patients with systolic heart failure

Background: Major depression is 4-5 times more common in heart failure than in the general population, and associated with adverse outcomes. This prospective study investigated somatic correlates of comorbid depression in patients with heart failure aiming to better understand the interrelation of both conditions.

Methods: We enrolled 702 consecutive patients hospitalized for heart failure with a left ventricular ejection fraction (LVEF) ≤ 40% (mean age 67 years, 71% male). Suspected episodes of depression were identified using the Patient Health Questionnaire (PHQ-9). A score >11 (9-11) was defined as suspected major (minor) depression.

Results: The prevalence of major (minor) depression was 24% (15%). Major depression was more common in women (30%) than men (22%, p = 0.02). In multivariable analysis, history of depression, (OR 3.09, 95%CI 1.98-4.82, p < 0.001), New York Heart Association class (OR 2.07 per class, 95%CI 1.52-2.81, p<0.001), leukocyte count >8000/mm(3) (OR 1.50, 95%CI 1.03-2.17, p = 0.032), and obstructive pulmonary disease (OR 1.61, 95%CI 1.04-2.50, p = 0.033) correlated independently with higher prevalence rates of major depression. Hemoglobin (OR 0.87 per g/dL, 95%CI 0.79-0.96, p = 0.005), and treatment with 3-hydroxy-3-methylglutaryl-coenzyme-A-reductase inhibitors (OR 0.66, 95%CI 0.45-0.98, p = 0.039) correlated independently with lower prevalence rates. Female sex, diabetes, peripheral edema, hyperuricemia, cholesterol <150 mg/dL, LVEF <30%, peripheral vascular disease, diuretics, and renal dysfunction were predictive only in univariable models.

Conclusions: The high prevalence of major depression in patients with heart failure seems closely linked to various typical clinical features of this syndrome. Whether this implicates differential therapeutic needs in patients with comorbid compared with primary depression requires further investigation.